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This research work has as main objective to propose an econometrical model with panel data, validated by empirical analysis, to identify the impacts in the results of the company, after the implementation of an ample salesforce compensation program. Additionally, is intended to identify if the different social-economic profiles of the employees can bring different results with the implantation of the program. The analysis is based on a change in the wage structure of the salesforce occurred in the company in 2005. This "natural experiment" was basic for the econometrical analysis, with macroeconomic, microeconomic and social-economic variables and the introduction of the program. To the end of the empirical study, being based on research carried through in authors as Ehrenberg (2000), Robert Milgrom (1992), Misra (2005), Coughlan (1989), Lazear (2000), Basu (1985) and in the J. Macedo S/A, the main objective was achieved, in other words, it was demonstrated that the implementation of the new compensation model brought a strong positive result on the volume sold. The estimation of the coefficient of the dummy variable, representative of the implementation of the program, evidenced, with high statistic significance degree, a monthly increase of 32.8 tons in the average of the amount sold for salesman.

The integrated studies if have become one of the forms of analysis of the complex relation man-nature. This makes of the geossistêmico method the main instrument of interpretation of the dynamics of the landscape and the intrinsic relations to same with a the antropogênica action. Of this form, the present dissertação focuses the integrated studies of the geoambientais units and the impacts in the paraense coastal zone, specifically the Island of Algodoal-Maiandeua/PA, located the 170 km of the capital - Belém. Geossistema was the starting point of the present analysis, focusing the localization, the interpretation, and the espacialização as objective generality of the research. Geoambientais, characteristic units had been defined geologic-geomorfológicas, taking in consideration the forms of use and occupation. The thematic cartography became continuous process and synthesis of the research, being primordial in the localization of the main forms of use and occupation, as well as in the estruturação of the proposal of the ecozoneamento disciplining some uses. Sugestiona, still, a plan of management integrated of the Coastal Zone as end item of the present work. This research searched to be the base of a new estruturação of the territory better to equate the existing ambient problems in the studied area.

O conceito de humanização tem ocupado um lugar de destaque nas atuais propostas de reconstrução das práticas de saúde no Brasil, no sentido de sua maior integralidade, efetividade e acesso. O Programa Saúde da Família condiz com a proposta de humanização do setor saúde, por propor mudanças no modelo assistencial tradicional a partir de ações voltadas para a atenção primária centrada na família. Estudo transversal, domiciliar, quantitativo, teve por finalidade avaliar a atenção básica de Fortaleza, sob a ótica de mães de crianças menores de 5 anos. Vale ressaltar que a capital do Ceará, Fortaleza, está passando por um processo de re-estruturação da atenção básica com a implantação de novas equipes de PSF. Com 98 unidades básicas de saúde e 304 equipes de PSF (45% de cobertura), a capital possui uma população estimada pelo IBGE para 2007 de 2.431.415 habitantes; destes, 234.674 são crianças menores de 5 anos. O estudo utilizou uma amostra probabilística constituída de 350 mães distribuídas nas seis Secretarias Regionais de Saúde de Fortaleza. A entrevista abordou aspectos relacionados às características socioeconômicas e demográficas, acessibilidade, humanização e satisfação com o atendimento. Para análise estatística foram calculadas as estimativas de proporções, qui-quadradro, OR e RR com intervalo de confiança de 95%, utilizando-se os programas Epi-info 6.04 e SSPS. Os resultados mostraram que 93,4% das famílias eram usuárias exclusivas do SUS. Quando indagadas sobre a trajetória de busca de atendimento 68% das mães procuravam os serviços de atenção básica, sendo que 89,7% procuravam diretamente o serviço de saúde. Quanto à relação estabelecida entre profissional/ cliente, 57,7% das mães sabia o nome do profissional que as atendeu, 63,7% informaram terem sido tratadas pelo nome por ocasião da consulta, 72,3% afirmaram que o profissional examinou a criança e deu orientações, 78,8% compreenderam as informações recebidas. Sugerindo uma vinculação positiva dos usuários aos serviços. Ao correlacionarmos algumas variáveis de assistência à saúde ao nível de satisfação pelo atendimento recebido, pudemos perceber claramente que as relações de comunicação entre os profissionais e as mães, apresentaram significância estatística. Dentre estas variáveis podemos apresentar: saber o nome do profissional (p<0.03); profissional tratou mãe/criança pelo nome (p=0.00), profissional examinou a criança e deu informações (p=0.00), mãe compreendeu todas as informações recebidas (p=0.00). Esse fato reforça a necessidade de uma adequação das consultas para todos os profissionais que atendem nas unidades de saúde da família de Fortaleza. Quanto ao nível de satisfação e a acessibilidade ao serviço, constatou-se que as variáveis que apresentaram significância estatística foram: satisfação por ter conseguido atendimento no dia que precisaram (p<0.05), tempo de espera para realização da consulta (p=0.00), e por terem sido encaminhadas ao PSF pelo ACS (p<0.04). Verificou-se ainda que, as salas de espera com entretenimento para a criança influenciam diretamente na satisfação das mães (p=0.00). O estudo mostrou que a maioria das mães (62,3%) esta satisfeita com o atendimento recebido por seus filhos nos serviços de saúde em Fortaleza, no bojo dessa satisfação, os profissionais mais destacados foram os médicos.

Our objective was to describe, in a historical perspective, the epidemiological profile of plague in the State of Ceará since 1900 and the evolution of the activities of the disease control from 1980 to 2008. We carried out a descriptive study using an historical approach based on the oral history for the construction of epidemiological and operational scenarios and a review of the historical and epidemiological information about the plague control program. To strengthen the information obtained, we conducted interviews with experts in the area. Historical records of human cases have been recovered only from 1935, and periods of intense activity and others of quiescence were identified. It is noteworthy that in the years 1980 plague persisted as endemic in Serra da Ibiapaba until 1986. In the period from 1982 to 1985 there was an outbreak in Serra de Baturité with 89 confirmed human cases; a rise of the rodents’ population and significant increasing in the activities of the program were observed. In the 1990s, only three human cases were confirmed in Serra da Ibiapaba and in 2005 another case was confirmed in Serra da Pedra Branca. The decline of human cases after 1986 led to the reduction of the program activities. For several decades the activities of the Plague Control Program (PCP) included health education, active search for plague activity and collection of specimens for bacteriological and serological analysis. Serological surveys in domestic carnivores (dogs and cats) predators of rodents were introduced into the routine of PCP in 1989 to monitor Y. pestis activities in the foci proving the most effective tool to detect the zoonosis activities in the foci. In spite of the occurrence of positivity peaks detected in 1997, 2001 and 2005, this activity has been diminished in the state and the present recommendation is to restrict the serological surveys to canine samples only. The Ceará foci are located in the ecological complexes of the “serras” Baturité, Machado, Matas, Pedra Branca, Uruburetama, Ibiapaba and Araripe. The foci area were formerly dealt as ecological units; however after the political/administrative division of the areas, in view of the “decentralization process”, they are now scattered among the “Regionais”. The Ceará foci are among the most important in Brazil, both by the number of human cases and by evidence of the permanent circulation of the bacterium. The persistence of plague in the state should therefore be considered a real and permanent risk in these regions, which may extend to other places, including urban centers, making it imperative that health professionals are prepared. Therefore, to ensure the monitoring of the foci, it is essential to maintain surveillance under the ecological approach, to enable the adoption of appropriate control measures for protection of human populations in focal areas.

Objectives: characterize eating habits and possible risk factors associated with Eating Disorders, amongst female adolescents in Fortaleza-CE, Brazil. Methodology: transversal study, with 652 women between 14 and 20 years of age, students of the second year of Middle-level education. The Bulimic Investigatory Test Edinburgh (BITE), the Body Shape Questionnaire (BSQ) and the Eating Attitudes Test (EAT-26) were used. Results: 73.6% of the subjects are out of risk for development of an Eating Disorder, 25.2% are at risk and in 1.2% a strong possibility of eating disorder in course was found. The proportion of adolescents who showed risky habits was greater in private schools (p<0.05). According to the EAT-26, 9% of the sample showed a score (>=21) which characterizes them as being at risk and practicing pathological eating habits. The BSQ indicated that 36.2% of the adolescents showed concern with their body image (BI); of these, 61% (n=236) were concerned to a degree considered mild, 26.3% showed a moderate concern and 12.7% showed serious concern with BI. Students at public and private schools demonstrated a similar desire to be thin, but adolescents from private schools more frequently used inappropriate practices in order to reach that wish. Conclusion: Adolescents who demonstrate eating disorders in their clinical form, are a rare phenomenon in public and private schools in Fortaleza, whilst the symptoms of eating disorder, either isolated or in small groups, occur with relevant frequency amongst the population studied.

Introduction As a result to the population aging, changes in demographic and epidemiological profile is public health problem, entailing the need to develop health policies and practices for the population. Fortaleza is a city of two and a half million inhabitants, of which 7.48% are elderly. The assessment of how the care for the elderly occurs in health assistance networks in Fortaleza produces information that can support the decision taken by the municipal government. Purpose Understanding how the way of caring for the elderly takes place in five health care networks in Fortaleza, in the perception of managers acting in this scenario. Methodology A qualitative study with descriptive approach and focus group technique. The Discourse of the Collective Subject was used to organize the findings (LEFÉVRE, LEFÉVRE, 2006). Results In the Family Health assistance network (so called Estratégia Saúde da Família), the actions of health promotion and introduction of the recording book of the elderly as a working tool are highlighted. A significant unmet demand was observed due to the lack of specialized services in caring for the elderly in the Specialized assistance network. Specific care for the elderly was not observed in the Hospital assistance network, as he is seen as common user. In the Emergency assistance network, the removal is included as a priority, and in the hospital, the service applied is according to severity. In Mental Health assistance network, there is a psychosocial approach to community involvement and intersectorial coordination. Final considerations Among the main findings of this study is that the way of care for the elderly in the city of Fortaleza is still weak, where some strands are misaligned, or broken, compromising the continuity of service. Given the state of demographic transition and the demographic and epidemiological profile, there is a need for better integration of health care, anchored in the Family Health Strategy as well as the structuring of new specialized services, aiming to improve care for the elderly population of Fortaleza.

Esta dissertação se propõe a mostrar um outro olhar ao estudo da Carcinicultura, ao realizar uma investigação geográfica, selecionando um jornal local, a partir de sua produção discursiva. O estudo investiga de que maneira o discurso jornalístico opera na construção de representações sobre essa atividade. Para isso, é necessário percebê-lo como um constituidor de significados, onde se exercem e travam lutas para produzir uma suposta verdade/realidade. Ao analisar as matérias jornalísticas, como discursos construídos culturalmente, percebe-se o modo como as representações estão sendo elaboradas. As ferramentas teóricas norteadoras desta pesquisa foram fornecidas pela Geografia Cultural, as quais possibilitaram uma nova leitura sobre o assunto. A pesquisa busca compreender as representações elaboradas pelo jornal O POVO, um dos mais importantes veículos da mídia impressa do Ceará, sobre a Carcinicultura em três períodos: de 1978-1984; 1990-1994 e de 2000-2004. A divisão desses períodos está alicerçada nos critérios estabelecidos pelo IBAMA e SEMACE em seus estudos sobre a questão. O cultivo de camarão começa a ser veiculado pelo jornal na década de 1970, mas somente na década de 1990 que conquista uma maior notoriedade na agenda pública. A metodologia utilizada consiste em um levantamento de reportagens que tratam, de alguma forma, a temática da Carcinicultura. Considero como campo da pesquisa as edições diárias do jornal O POVO desses períodos. O jornal, ao ser pensado como artefato cultural, está sendo visto como um local de produção de saberes sobre a atividade camaroneira, auxiliando na formação da opinião pública. O estudo, ao estar pautado na análise da construção discursiva, teve que se direcionar a examinar as estratégias acionadas para elaborar os ditos sobre a Carcinicultura. Neste sentido, descrevo e problematizo o funcionamento dos discursos jornalísticos. No primeiro período, 1978-1984, em Ao encontro do Eldorado, observo dizeres que apontam a Carcinicultura como algo benéfico, uma importante saída para a crise do sal, uma atividade para inserir o Ceará e o Nordeste no circuito nacional de produção. À medida que avança para os períodos seguintes, o discurso do referido jornal desloca-se para outros significados. Assim, a atividade camaroneira é, por um longo período, apontada pelo jornal como a única saída viável para o Nordeste. Isso passa a ser questionado. A expansão da Carcinicultura no Brasil é bastante expressiva nas últimas décadas. Esse progresso está relacionado à introdução e ao cultivo da espécie Litopenaeus vannamei, ao uso de técnicas de melhoramento, tanto voltadas para o aumento da produção como da reprodução do camarão, incentivos governamentais e à utilização indiscriminada de certas áreas litorâneas No segundo período, 1990-1994, A promessa da redenção econômica ainda permanece. O discurso da atividade, como uma coisa muito promissora, no início está presente, para, posteriormente, a atividade passar a ser vista não mais como algo tão benéfico. Para o terceiro período, dede 2000-2004, O sonho acabou, embora o cultivo do camarão, naquele momento, já fosse uma das mais importantes atividades do setor primário nordestino, ocupando lugar de destaque na pauta de exportação do estado do Ceará. Os enunciados dos discursos jornalísticos passam a registrar essa prática como uma atividade preocupante pela forma como é realizada, isto é, sendo a causa de inúmeros problemas socioambientais. A prática do cultivo de camarão, em áreas de mangues e suas adjacências, vêm provocando uma série de danos, tanto para o ambiente, como para inúmeras comunidades que dependem do ecossistema manguezal para sobreviverem. Nesse sentido, o discurso do jornal, ao deslocar esses dizeres sobre a Carcinicultura, mostra como atua estrategicamente para a naturalização dos significados. Com isso, deve ser entendido não apenas como um informador dos acontecimentos, dos fatos, mas como um instrumento que estabelece verdades, as suas.

The Aedes albopictus mosquito is a vector of several different arboviruses and uses natural breeding sites for its reproduction. The objective of this study was to describe the determinants of Ae. albopictus infestation in verdant areas of Fortaleza, Ceará (Brazil). It is a descriptive, exploratory study conducted in four areas of the city with a high density of vegetation and the presence of natural breeding sites. The environmental, populational and physical aspects of these areas were detailed as well as the possibility that they serve as a source of protection for viable eggs in the dry season. The study was composed of two parts conducted throughout 2007. The first was undertaken during the rainy season with water samples taken from natural and artificial breeding sites. The second took place in the dry season and samples were collected only from within the natural breeding sites. These areas were classified in accordance with the literature and correlated with the presence of immature forms of Ae. albopictus. During the rainy period, of the 62 breeding areas in existence, 49 (79%) were natural and of these, 25 (51%) were infested with Ae. albopictus. Among the trees that tested positively in these areas, the genera Terminalia, Acacia, Bambusa and Magnifera stood out, while in the artificial breeding sites tires, opened coconuts and small plastic containers were most common. Ae. albopictus was the lone inhabitant of 24 (96%) of the natural breeding sites and the greatest density of larvae was found in areas of lesser vegetation and closer to the soil, whereas tires held the higher density within the artificial areas. Nine (37.5%) natural breeding sites continued to be infested in the two seasons and five others only in the rainy season (14; 30.4%; CI 95%: 16.62 – 44.25). In general terms, there was infestation of 51.0% of natural breeding only in the rainy season, 30.4% in only the dry season and 63.8% if considered in totality. One can conclude that trees of several genera in natural breeding areas offer adequate conditions for the development of immature forms of Ae. albopictus at several stages. In this sense, there may be expanded propagation in the next rainy season in the urban areas of Fortaleza. This scenario amplifies the challenges inherent in the control of dengue fever and other infectious diseases transmitted by this vector.

The research Veraneio Marítimo e Expansão Metropolitana no Ceará: Fortaleza em Aquiraz (Maritime Summering and Metropolis expansion: Fortaleza in Aquiraz), has, as a general goal, to understand the relation between the valorization of coast spaces and the expansion of the metropolis of Ceará. The doing of modern maritime activities (sea baths, tourism, summering), especially summering, represent new possibilities of approximation of society with the sea, detaching the coast space as the main place that populations of big cities have to have fun and to live. This way, the urbanization becomes a process related to the dissemination of the modern maritime life. The modern maritime life is spread out for the society of Fortaleza for the whole state of Ceara from the 70’s, and first reaches the small citys of Aquiraz and Caucaia, members since 1973 of the initial formation of the metropolitan region of Fortaleza. To understand this process, the case of the expansion of the maritime summering thru the cost of Aquiraz was analized. When you understand the influence of the metropolis in the spreading of maritime summering, you see how the coast space is reached by the urban tissue of Fortaleza. The summering people, real estate entrepreneurs, the people who live in local beaches, the public power of small cities and States are social subjects involved in the process of the making of un urban discontinous morphology, characterized by urban divisions and accumulations of second residences. The household-electric, the car traffic, the tv, the habits, the differentiated standard of accessing the land generates indicative unfoldings of the arrival of the urban one in the littoral space of Aquiraz. The buildings of summering represent new trends related to the desire of isolation, associated to the people who live in Fortaleza. The analysis of the nuclei of Iguape, Prainha, Porto das Dunas and Plug demonstrates that the summering in Aquiraz constitutes territories, in which the metropolis and its society exist. Analyzing the Managing Plan of Urban Development of Aquiraz, concluded in the year of 2001, it was understood that the small city public power, based on the plans of government of the state public power, legitimizes the process of valuation of the littoral space and assigns, through laws and zonings, preferential areas for the expansion of the process of littoral valuation. It is proven valuation of the littoral spaces as a necessary process for the expansion of the metropolis for the metropolitans small cities pertaining to the state of Ceará.

The current modifications observed in Performance‘s Model of the State of Ceará at Public Politics for the regional- urban development, since from middles of the eighties, especially in Solid of Baturité-CE, causes the present researche. It also points the process of (re)production in area, , coming of competitive integration in the cities ‗ market in search os global surplus value and of ―incomes monopolists‖ of the Tourist activity, mainly in the highland sub-area of the Solid area. It understands itself that studying the process of production at Urban Space-regional, of study‘s area, it can be understood the spaces practices on present and in matter stimulated them by the State. It realizes this process as a need of the Capitalism for its development and maintenance with the continuous production of the space transformed in merchandise. For the performance‘s analysis , were taken it reference some programs and regional development plans done by the State in different administration scales. For us to arrive to the objectives of the research , we will use this return to the pas, proposed in the method , but being evidenced that the study seeks the present, being the necessary historical study for understanding of the process, for us we won‘t fall in the trap of a simple historical analysis. The research starts about the qualitative and quantitative data analysis, doing a little use of statistical techniques , it was analyzes the phenomena described in the documental collection, by the bibliographical research , and confronted them with the direct observation of the atmosphere, stage of the research – municipal districts of the sub-highland area of the Solid of Baturité. So, get difficult with the mentioned problems, we locate a positive performance or solid with concretes results of the planning, because all of the areas mentioned as priority at programs and development projects for the area, pass for structural problems. It stands out, like this, the lack of a larger performance in public politics as the ones that works with the offer services and equipments of buses consumption buses, that in a touristic region, before they serve tourists , are indispensable for the local population.

Through a geoenvironmental analysis, this work is related to the study of a hidrographic basin as a geographical analysis category. The hydrographic basin of the Apodi-Mossoró river represents 27% of the territory of the state of Rio Grande do Norte, covering a total area of 14.271 km2, having a spatial cutting for this study, the lower course of the mentioned river, which covers 973 km2. Regarding the geodiversity, it is characterized as an area with a presence of a plateau, coastal tablelands, fluviomarine plain, of coastal band with beaches, cliffs and dunes. In this context, the work had the objective to do an analysis of the environmental framework considering the dynamics of the use and occupation, through a study of a multitemporal scale from 1989 to 2009, basically identifying and putting on a spatial scale the geoenvironmental units, the pressure of use, using remote sensoring, the geographical information system for the handling and information crossing, qualitative quantitative research, obtaining as a final result a set of seven maps. The result also indicated, in hectares, a percentage of economic activities in 1989 as: 16,4% of cyclical cultures, 19,2% of perennial culture, 0,04% of petroliferous areas, 64,4 % of salt-mines (craft and industrial). In 2009, the perennial cultures represented 32,7% , the petroliferous activities 33,4%, saltmines 34% (craft and industrial) and the breeding of crabs and other crustaceous 2%. Therefore, it was observed a growth of 126% for perennial cultures, 1.847% for petroliferous activities and 28,50% for alt-mine activities. We can understand that the different forms of use alters the environmental dynamics of the studied area, contributing to the intensification of fluvial processes, to the deposition of sediments, to the silting up process, to the erosion, to the destruction of cilliary woods and to the ecosystem´s mangal. The changes in the low course of Apodi-Mossoró river, correspond to the very significant modifications of the original morphology and in the dynamics of geomorphological processes, in the rate of average annual fluvial discharge and in the rate of transportation of the sediments. Those facts, associated with the environments of inadequate occupation foster the emergence of areas with high exposure of environmental quality.

This study refers to an investigation about the relations between labour market and gender in Fortaleza (CE), focusing on occupational areas aiming at understanding how women are positioned, especially in 2001 and 2005. It is pertinent due to helping to show that positioning and circulating places addressed to women are still very much related to gender division. Its theoretical field is Cultural Geography, particularly a branch that has discussed, problematised and made use of a theoretical articulation’s fruitfulness in the poststructuralist perspectives, as it helps to understand that these relations are constructed in the cultural practices to position women and men in different occupational fields. We have sought to understand gender relations from the cultural practices. In this sense, gender relations are understood as those which bring into play (fe)male representations and symbols whose powers are directed to social practices to stay alive in the society’s value set. Therefore, gender use as the analysis focus lies at deconstructing, displacing meanings that were culturally constructed, and showing that when they are marked around gender difference, they can and should be issued, questioned and problematised. To understand these issues we have sought for the research data at the Censos do Instituto Brasileiro de Geografia e Estatística (IBGE), Anuários Estatísticos do Sistema Nacional de Empregos, and Instituto de Desenvolvimento do Trabalho (SINE/IDT-CE) and da Relação Anual das Informações Sociais (RAIS) in 2001 and 2005, as they provided accessibility and updating. From the collection, some variables that allow us to understand the studied problematic, were observed: occupational field, age, instruction degree, salary, and working hours of the workers in Fortaleza. With the crossing of variables, we have constructed the theme thread for the research: local labour occupation and distribution, which provided discussions of the studied problematic. This has allowed us to reflect about and understand the configuration of the women in the labour market as cultural practices.

Tuberculosis (TB) is a disease that has challenged mankind since antiquity. It was believed that with the new technology, infectious diseases would be easily tracked and banned. The reality has been presented differently, despite advances in knowledge of tuberculosis and technology available for its control, the current picture is far from the targets set by governments. It is essential to the study of factors associated with pulmonary tuberculosis, since they are present in the prime-infeccção in relapse and multi-drug resistant pulmonary TB. Knowledge of data related to TB in the general population and specific groups at risk for TB are crucial to assess the epidemiological reality of our environment allowing proper organization of prevention and care activities. OBJECTIVE: To investigate factors associated with the diagnosis of TB, the frequency and characteristics of pulmonary tuberculosis with respiratory symptoms in three routine health services in Fortaleza. Cross-sectional study of quantitative accomplished through the application of a questionnaire in patients from three health units of Fortaleza. Respondents were divided on outcome of patients with tuberculosis and non tuberculosis outcome. We studied the influence of sociodemographic factors, housing conditions, behavioral factors, antecedents related to TB infection and clinical outcome for tuberculosis. RESULTS: The rate of pulmonary TB patients with respiratory symptoms among the study sample was 41.2%, but this data can not be extrapolated, the socio demographic and clinical outcome independently associated with TB were cough, fever and weight loss considering the level of six percent of significance. The main method used to assist diagnosis of TB in patients suspected of units studied in Fortaleza was the chest radiograph. The susceptibility profile of Mycobacterium tuberculosis showed 8.82 percent of MDR strains and sensitivity to isoniazid, rifampin, ethambutol and streptomycin from 88.23 percent in the samples taken and can not be extrapolated. If all TSA excluded from the hospital and found only Messejana TSA health posts, the resistance value reduces to a case of MDR 28 to TSA made, representing 3.6% of the sample, most patients with pulmonary TB had AFB positive only a cross, which may mean duration of disease not so long.

The aim of this study was to identify the socioeconomic and environmental factors related to Hansen’s disease in the State of Ceará. A descriptive study was carried out in three municipalities in the State of Ceará with a high finding and prevalence rate of Hansen’s disease in the last ten years in Senator Pompeu, Iguatu and Juazeiro do Norte. The areas where the cases took place were described, and it was also observed if there were water bodies frequently used by the population in the surroundings. The possibility of other factors is speculated, not only the person-person transmission, just like the water, to participate as an infection source for the Mycobacterium leprae. A case-control study in the municipalities of Fortaleza, Juazeiro do Norte, Sobral, and Morada Nova was accomplished in 2001, starting from this pilot descriptive study, showed that the proximity to natural water bodies, and the frequent contact with them emerged as a significant risk factor for Hansen’s disease in Ceará. A determination model of the Hansen’s disease was idealized based on the disease epidemiology. A univaried analysis was accomplished in each block to know which variables would be analyzed through a logistic regression. After that analysis, considering the idealized model, a multivaried hierarchical analysis was used where each explanatory block was analyzed separately, on a discending scale, and the following blocks were adjusted by the significant variables of the ascending block(s). The results found reinforce previous discoveries, in other studies, of the association of Hansen’s disease with low educational levels, extreme poverty, and the lack of hygiene was also shown to be associated with Hansen’s disease. As well as the people who usually take frequent baths in dams, swamps or rivers had a larger risk of developing Hansen’s disease. Having a vaccine scar was shown as an important protection factor against Hansen’s disease.

The river basin committees - CBH were established in Brazil by Law 9433/97, the National Policy of Water Resources, with the goal of enabling social participation in conducting the process of water management, through the representation of various sectors of society, to discuss and define paths for a given river basin where they live and work. In this context, We made an analysis of the trajectory of the Watershed Committee of the Metropolitan Region of Fortaleza - CBH-RMF, the state of Ceara, in order to understand whether the activities of that committee has been successful in addressing the problems environmental Metropolitan Watershed, and what limitations on the articulation of policies and in the effectiveness of participatory water management. As a basis for the studies we were performed literature searches, analysis of documents, records, interviews and observation of committee meetings. The research concluded that the CBH-RMF has taken relevant steps, especially in making diagnoses and conducting some procedures. However, this policy has limitations in its implementation because it is poorly distributed and discussed with the company. It is necessary to greater institutional coordination and social participation to reflect the views and interests of the community in relation to water management.

Após o surgimento da terapia anti-retroviral (TARV), tem sido observado o desenvolvimento de um perfil crônico-degenerativo caracterizado pela presença de diversos distúrbios endócrino-metabólicos, como síndrome metabólica, diabetes mellitus tipo 2 (DM2), dislipidemia e lipodistrofia, condições reconhecidamente associadas a aumento do risco cardiovascular. Além disso, reconhece-se que o próprio HIV desempenha papel significativo no surgimento destas alterações. No entanto, até o momento, dispõe-se de dados limitados sobre a epidemiologia das complicações metabólicas associadas ao HIV no Brasil e em especial no estado do Ceará. O objetivo deste estudo foi determinar a prevalência de distúrbios metabólicos em pacientes portadores de infecção pelo HIV/Aids acompanhados no Hospital São José de Doenças Infecciosas, considerado centro de referência para o atendimento desta condição no estado. Foi realizado um estudo transversal, onde foram incluídos 144 pacientes atendidos no ambulatório de HIV/Aids entre os meses de janeiro a maio de 2010, selecionados de forma sequencial. Para o grupo controle, foram selecionados aleatoriamente 95 pacientes sem infecção pelo HIV. Os pacientes foram submetidos à avaliação médica, exame físico e coleta de amostras de sangue pela manhã em jejum, para determinações de glicose, insulina, colesterol total, lipoproteína de alta densidade (HDL), triglicerídeos, contagem de linfócitos T CD4+ e carga viral do HIV. Foi calculado o HOMA-IR para inferir a resistência à insulina e foi estimado o risco cardiovascular pelo Escore de Risco Framingham (ERF). Os dados foram submetidos à análise estatística, sendo utilizado para esse fim, o programa StataTM, versão 9.1. Na análise dos dados, foram utilizados o teste t de Student, teste de Mann-Whitney, correlação linear de Spearman, qui-quadrado, teste exato de Fisher e teste de X2 Mantel-Haenszel, com nível de significância estatística de 5% (p<0,05). Foi observada uma elevada prevalência de DM2 (7,3% vs. 1,1%; p<0,05), HDL baixo (70,3% vs. 46,1%; p<0,05) e hipertrigliceridemia (54,3% vs. 32,6%; p<0,05) nos pacientes com infecção pelo HIV/Aids em comparação ao grupo controle. DM2 (9,5% vs. 2,5%; p<0,05) e hipertrigliceridemia (68,4% vs. 41,0%; p<0,05) foram mais freqüentes entre os pacientes em uso de TARV vs. sem TARV, ao passo que HDL baixo foi encontrado na mesma proporção entre indivíduos expostos e não-expostos à TARV (68,4% vs. 75,0%; p>0,05). Houve uma menor proporção de pacientes com medida de CA aumentada no grupo com infecção pelo HIV em uso de TARV versus controle (18,6% vs. 42,1%; p<0,05). Foi observado aumento da proporção de indivíduos com risco maior que 20% em 10 anos (alto risco) no grupo de pacientes com infecção pelo HIV/Aids usuários da TARV versus controle (16,7% vs. 3,2%; p<0,05). Não houve diferença na prevalência de síndrome metabólica entre os grupos com e sem infecção pelo HIV (26,4% vs. 31,9%; p>0,05). Lipoatrofia de tecido subcutâneo foi observada em 28,8% dos pacientes infectados pelo HIV, exclusivamente entre aqueles em tratamento. Lipohipertrofia foi detectada em 14,6% dos indivíduos em TARV. Lipodistrofia associada ao HIV (ou seja, presença de lipoatrofia ou de lipohipertrofia) foi observada em 39,4% dos pacientes com infecção pelo HIV em uso da TARV. Em conclusão, estes dados indicam a elevada prevalência de alterações metabólicas entre os pacientes com infecção pelo HIV no nosso meio e orientam que, no âmbito da saúde pública, é preciso considerar a necessidade de desenvolvimento de estratégias que favoreçam a redução das complicações metabólicas e das doenças cardiovasculares neste grupo susceptível.

Introduction – The study of the risk factors of death among young children under one year of age makes it possible the elucidation of the net of determinant events, identification of exposed groups as well as the necessities of the health of population subgroups permitting the programming of interventions aimed at the reduction of infant deaths. The interest in relating records in different data bases has been increasing progressively according to the increasing possibility of large computerized data bases in the health area. The present study shows the results of the linkage of information of the Information System on Live Births (SINASC) and Mortality Information System (SIM) in the determination of infant deaths in the town of Maracanaú, Ceará. Objective – To analyze risk factors for the death of young children under one year of age, in the town of Maracanaú, in the state of Ceará, between the years 2000 and 2002, through the linkage of the information from SINASC and SIM. Methodology – Study of the retrospective cohort of live births. The population constituted of 11,127 live births with certificate of born alive (DN) filled out, between January 1, 2000 and December 31, 2002, children of mothers residing in Maracanaú and 119 infant deaths connected with this cohort of live births, with death certificates (DO) or instrument of investigation of infant death filled out occurred, between January 1, 2000 and December 31, 2003. The risk factors for the infant death were estimated through the logistic regression. Results and Discussion –The model of the multi-variable analyses for the infant death showed that the underweight born-alive when coming to life presented risks of death 3 times bigger before reaching the first year of age when compared with the ones with weights the same as or bigger than 2,500g (OR = 3.16; IC95% 1.58-6.35), the premature born-alive had the death risk 2.7 higher than those of the term (OR = 2.70; IC95% 1.25-5.86), born-alive from mothers with pre-natal appointment the same as or lower than 6 (OR = 2.05; IC95% 1.15-3.64) and born-alive whose Apgar score in the first (OR = 4.40; IC95% 2.48-7.81) and fifth (OR = 5.5; IC95% 2.75-11.20) minutes of life were lower than seven. The low birth weight, values of Apgar score lower than seven in the first and fifth minute of life, the pre-maturity and the number of pre-natal appointments lower than six presented in the cohort in study strong association with death before reaching the first year of life, reinforcing the studies described in the literature that they are variables strongly predictors of infant mortality. This study made it possible the use of data bases of birth and death, through of use of linkage procedure, suggesting its use by the city level of attention to health as well as the continuous vigilance and offer of adequate and technologically advanced assistance in each one of the levels of complexity of the local health system to the subgroup of newly-born with higher risk of death in the first year of age besides the guarantee of proper and conducted pre-natal assistance of good quality and the organization of the assistance in hierarchy and regional systems.

The relationship between maternal blood glucose and macrossomia has being an issue of controversy among different studies. In spite of the evidences that a linear and statistical significant association between maternal blood glucose and macrossomia do exists, no threshold glucose value has being identified as a major risk of this endpoint when using the 75g-OGTT in pregnancy. There are a lack of studies of statistical significance that clarify about the relationship between this test results and fetal growth. The aims of this study is to investigate the characteristics of maternal blood glucose on 75g – OGTT following the WHO criteria and an increased risk of large for gestational age infants in a cohort of 3942 woman from the Brazilian Study for Gestational Diabetes (EBDG,1991-1995). It has being the larger study about gestational diabetes that has being done in our Country and had validated the diagnostic of gestational Diabetes with the WHO criteria in relation to the endpoints such as macrosomia (SCHMIDT et al, 2001). A receiver-Operator characteristic (ROC) curve for the prediction of macrossomia were constructed for the feasting, one and two hours of 75-g glucose load values to determine the plasma glucose threshold value that yielded the highest combined sensitivity and specificity for the prediction of abnormal neonatal birth weight. An investigation about the proprieties of sensitivity and specificity of the cut points of glucose values on the test, distributed in terms of percentil was performed, and also these proprieties if having et least 1, et least two or the three values above certain percentil of the glucose values distribution. The results of these analyses had shown a statistical significant correlation between glucose values and macrossomia on the 75-g load ( p=0,000 ).The analyses of the TOTG-75g load values on ROC curve, with macrossomia as the end point , has shown no inflection point that discriminate a major risk of macrossomia. The discriminative power of the curve in fasting state, 1 hour and two hours is week , as shown by the area under the curve of 0,557 for fasting (CI: 527-588); 0,587 for 1hour values,( CI: 557-617): and 0,574 ( CI: 544-604) for 2 hours. Using the linear tendency test of Fleiss, (Fleiss, 1981) a constant increment on the incidence of macrossomia was observed, as the cut point of glycemia goes up on the range of the percentiles of distribution of glucose values, in such a way that do not exist a threshold level of glycemia that discriminate between an infant with macrossomia from other with adequate weight for gestational age. This study intends to contribute with its data for the discussions about sensible and specific criteria that define predictor’s end points in pregnancy.

Knowledge about the oral health status and the use of dental services for people living with HIV / AIDS (PLWHA) is a factor important to plan actions in order to provide a focus Quality dental care to this population. This study aimed to identify the main factors related to utilization of dental services and oral health status of PLWHA in Fortaleza - Ceará. To this end, A transversal study with a quantitative approach, developed August to December 2009 with PLWHA who were accompanying us infectious disease clinics of a university hospital (HUWC) and Medical Specialties Center José de Alencar (CEMJA). We collected Data on the clinical and laboratory such persons, on conditions sociodemographic, utilization of dental services and the conditions of oral health of this population. The study included 173 patients; 72.3% male and 27.7% female, with a mean age of 36.4 years. Of these, 50.9% (88/173) said they had not yet consulted with a dentist after HIV infection and 52.6% (91/173) of participants said not disclose their HIV status to the dentist before a treatment dentistry. The study also showed that searching for dental care public services (PR: 2.39, 95% CI 1.23 to 4.16, p <0.001) and reveal the condition serology for the dentist (PR: 2.11, 95% CI: 1.03 - 4.31, p <0.001) were significantly associated with having difficulty in accessing these services. There was a high prevalence (61.3%), periodontal disease (87.3%) and changes in oral mucosa (12.7%) in this population. It was evident that there is no statistically significant association between caries and immunological conditions of seropositive patients (p> 0.05). However, the presence of changes in oral mucosa was associated statistically significant with low CD4 count (PR: 4.20; 95% CI: 1.74 to 10.13, p <0.001) and high levels of plasma viral load (PR: 4.74; 95% CI: 2.11 to 10.67, p <0.001). This study concluded that there is at investigated population a high prevalence of oral diseases, showing therefore, great need for dental treatment. However, also observed that there are limitations on access to these people oral health services.

We review in this work the principal properties of single polyacetylene chain from a theoretical field formalism. Then, we study a coupled polyacetylene chain using the same formalism and verify that this system presents a gap in its electronic band structure. This energy gap is calculated in terms of a quantized effective mass that depends on the coupling between the polyacetylene chains. As the coupling decreases the gap vanishes and we restore the previous results of one single polyacetylene chain not dimerized. We show that there is a chiral broken symmetry. We study also the behavior of coupled polyacetilene in presence of solitons. A formalism is developed to show that there is an oscillatory phenomenon of quantum character analogous to Bloch oscillations. The conductivity of the system is also calculated.